Pro Bono Case by Dr Wendy Gill
Supported by Straumann Group

Case Notes:
                    Miss Jamielyn
                  


Implant Team:
                    Dr Wendy Gill (Periodontist)
                    Dr Brendon Joyce (Prosthodontist)
                    Mr Sasha Negrini (Dental Technician) 

 

A 19-year-old patient was referred from her prosthodontist for implant placement to replace tooth 21. She had recently completed orthodontics, and the tooth was extracted due to trauma.
Clinical examination revealed a periodontally healthy patient who was motivated to maintain a future dental implant. Her ERA revealed a high aesthetic risk due to her full gingival display on smiling. The patient was aware of the risk of possible ongoing vertical growth of the maxilla leading to relative infraocclusion of the implant. Maintenance of bone support at the implant is critical in these cases and an internal connection, platform switched implant design was preferable.

Jamielyn had funded her orthodontic treatment and was a good candidate for the Straumann Group’s assistance.
Digital treatment planning was performed and a 3D printed guide constructed. The treatment plan included Guided Bone Regeneration for contour augmentation, and therefore surgery involved a full thickness flap with a single relieving incision at the 23distal. Implant placement achieved excellent primary stability, and a ‘bottle neck’ healing abutment was placed to maximise soft tissue thickness during healing. GBR was performed with bone xenograft and a collagen membrane. The flap was relieved and tension free closure achieved.

Healing was uneventful and the healing abutment was changed to a 5mm x 4mm flared abutment to achieve a reproducible emergence profile before impressions. The tooth was restored with a screw-retained, direct to fixture PFM veneered with Creation CC.

Follow up review showed excellent soft tissue health, 2mm probing depths with no BOP. The patient was very happy with aesthetics and has committed to a regular maintenance program.
She was very grateful to Straumann Group for the financial assistance. Jamielyn is currently studying science fulltime, helping to care for her partners two children and working a fulltime job. She has funded all her dental care and is now interested in pursuing dentistry as a future career.
 

Personal History

  • 19 years at presentation
  • Trauma to tooth 21 at 9 years of age
  • At completion of orthodontics (FFA)
  • Self funded orthodontics and will self fund surgery
  • Working full-time and studying full-time (Hoping to do dentistry)

Medical History

  • Woke up during a previous GA and had a seizure and very high BP
  • Prefers treatment under LA
  • Medications: OCP
  • No allergies

Consultation 

Examination

  • Periodontally healthy
  • Excellent plaque control
  • Impacted third molars
  • Caries free
  • Fixed retainers 13/12/11, 22/23

Site Assessment (see ERA)

  • Angled ridge
  • Labial defect
  • For digital planning
  • Implant: Straumann Bone Level
  • Contour Augmentation already required for aesthetics
  • No concern for primary stability, no advantage to use tapered
  • Advantages: biological compatibility, healing time, options for all componentry
  • For 3D printed stent and guided surgery

Surgery  28/03/2017

  • Treatment under LA: aseptic technique
  • 2.2mls art + adr infiltration buccal and palatal
  • Flap raised
  • Guided Osteotomy
  • 1 x PA
  • Site checked as proximity to incisal canal, all bone walls intact
  • Implant placed 30Ncm, excellent primary stability
  • ‘Bottle neck’ HA placed for improved buccal soft tissue bulk
  • Contour augmentation: bioss, bioguide
  • Flap advanced
  • Sutured
  • Suspension bridge fitted

‘Second stage’ surgery 01/08/2017

 

  • (delayed by patient)
  • 1.1mls art + adr, excess soft tissue at palatal removed
  • Healing abutment changed to 5mm x 4mm
  • Torque tested to 35Ncm

 

Final Restoration

  • Direct to Fixture, PFM, metal ceramic
  • Veneered with Creation CC